What are the effects of Levetiracetam (Keppra) after a seizure?

From the Guidelines

Keppra (levetiracetam) should be continued after a seizure, and the dose may need to be increased or another antiepileptic medication added, as evidenced by the most recent study in 2024 1. The management of seizures, particularly in the context of status epilepticus, is critical for reducing morbidity and mortality. According to the latest clinical policy from 2024 1, levetiracetam is one of the options for treating benzodiazepine-resistant status epilepticus, with approximately half of patients achieving cessation of seizures. Key considerations in the management of seizures include:

• Continuation of Keppra after a seizure, with potential dose adjustments or addition of another antiepileptic medication
• Monitoring for side effects, such as fatigue, dizziness, and mood changes
• Regular blood level checks, especially after dosage adjustments
• Keeping a seizure diary to track frequency and potential triggers
• Follow-up with a neurologist after any breakthrough seizure to reassess the treatment plan The use of levetiracetam, as studied in earlier research 2, has shown efficacy in stopping seizures, with a study demonstrating a 73% success rate in seizure cessation after infusion. However, the most recent and highest quality study from 2024 1 guides the current recommendation for the management of adult patients presenting to the emergency department with seizures.

From the FDA Drug Label

A total of 13.3% of levetiracetam patients experienced other behavioral symptoms (reported as aggression, agitation, anger, anxiety, apathy, depersonalization, depression, emotional lability, hostility, irritability, etc.) compared to 6. 2% of placebo patients. Approximately half of these patients reported these events within the first 4 weeks. A total of 1.7% of treated patients discontinued treatment due to these events, compared to 0.2% of placebo patients.

Post-seizure behavior with Keppra (levetiracetam):

• Common behavioral symptoms include aggression, agitation, anger, anxiety, apathy, depersonalization, depression, emotional lability, hostility, irritability, etc.
• Incidence: 13.3% of levetiracetam patients experienced these symptoms, compared to 6.2% of placebo patients.
• Onset: Approximately half of these patients reported these events within the first 4 weeks.
• Severity: 1.7% of treated patients discontinued treatment due to these events, compared to 0.2% of placebo patients 3.

From the Research

Keppra Post Seizure

• Keppra, also known as levetiracetam, is an antiepileptic drug used to treat seizures 4, 5, 6, 7.
• Studies have shown that levetiracetam is effective in reducing the frequency and severity of seizures, and is often used as a first-line treatment for partial onset seizures and generalized tonic-clonic seizures 4, 6.
• In terms of post-seizure state, levetiracetam has been shown to have a favorable effect on reducing the severity of post-seizure condition, as measured by the Liverpool Seizure Severity Scale 2.0 (LSSS2.0) and the Seizure Severity Questionnaire (SSQ) 7.
• Levetiracetam has also been compared to other antiepileptic drugs, such as lamotrigine and valproate, and has been found to have similar efficacy in controlling seizures, but with a better safety profile 6.
• The use of levetiracetam in the treatment of status epilepticus, a life-threatening condition characterized by prolonged seizures, has not been extensively studied, but it is not typically used as a first-line treatment for this condition 8.

Comparison to Other Antiepileptic Drugs

• Levetiracetam has been compared to other antiepileptic drugs, such as lamotrigine, valproate, and oxcarbazepine, and has been found to have similar efficacy in controlling seizures 4, 6, 7.
• Lamotrigine has been found to have a higher rate of failure in controlling seizures and myoclonic jerks compared to levetiracetam and valproate 6.
• Valproate has been found to have a similar efficacy to levetiracetam in controlling seizures, but with a higher rate of adverse effects 6.
• Oxcarbazepine has been found to have a favorable effect on reducing the severity of post-seizure condition, similar to levetiracetam 7.

Clinical Use

• Levetiracetam is typically started at a low dose and titrated slowly to the lowest maintenance dose possible, with the goal of achieving optimal seizure control while minimizing adverse effects 5.
• The choice of antiepileptic drug, including levetiracetam, should be individualized based on the patient's specific needs and medical history, and should take into account factors such as seizure type, frequency, and severity, as well as the presence of any comorbidities or concomitant medications 4, 5.